Thread by @MiscSusan

5 years ago today, I woke feeling fine, then quickly developed malaise. An hour later, I started to rigor. I know rigors are bad, but I thought (hoped?) it was viral. I developed horrible, diffuse abd pain, vomiting, and relentless rigors. I had no idea what was going on. 1/18

Too embarrassed to go to the ED, in case it was “just gastroenteritis,” I stayed in bed, taking ibuprofen and sipping water as I could. After 3 days, I asked my husband, also an intensivist, to take me to the ED. We went to his hospital, not mine. 2/18

I was so sick, and had been in this miasma of illness so long, I couldn’t give a coherent history. As an EM-CCM doc. I couldn’t remember the timeline or what I was feeling. 3/18

The ED team had no idea either, and my work-up was unclear. My LFTs were a little up, mild WBC, and ? UTI. With the abd pain and fevers, they got a CT scan, with trace fluid around the liver - called by the radiologist as concerning for Fitz-Hughes-Curtis. (It wasn’t.) 4/18

They had nothing definitive to keep me, and I went home. That night, I writhed in bed, moaning in pain, dry heaving on the barium from the CT. In the morning, I told my husband we had to go back to the ED. 5/18

On visit #2, I was more tachycardic, more tachypnic, my LFTs were up, and I had thrombocytopenia. When the ED attending said I was being admitted, I relaxed for the first time in days. No one knew what was wrong, but I was in good hands. They were going to take care of me. 6/18

But still no one knew what it was. The fevers and rigors continued. ID was consulted, and they were thinking tick-borne illness. Now, those who know me know that I detest nature. I would be the last person exposed to ticks, unless one attacked me on the T. 7/18

I couldn’t stop thinking of my recent encounter with a patient with HCV, who hemorrhaged in front of me in the ICU. I had been working on her, intubating her, placing lines, trying to save her, with her blood soaking my gown. HCV seemed far more likely than anaplasmosis. 8/18

At the end of hospital day 2, illness day 6, my blood cultures came back with Group A Strep bacteremia. I was so relieved - a diagnosis! And one that was treatable, no less. I was probably the happiest person on earth to be told they have Strep bacteremia. 9/18

Then complications started. My renal function declined, and I was given fluid. And more fluid. And more fluid. And I developed pneumonitis. Then, an ileus. An ileus is awful. I wouldn’t wish an ileus on anyone. I wretched so hard, I was sure I was going to rupture my aorta. 10/18

My weight was way up, volume overloaded, anasarcic. I was significantly hypokalemic. I became delirious – I lost at least a couple days in there. 11/18

The staff was fastidious about my early mobilization. I am such a believer in it for others – when it was my turn, it felt like torture. My swollen abdomen sloshed with fluid. My legs tight with edema screamed with each step. I was fatigued and dyspneic with any movement. 12/18

The antibiotics were working, and eventually, all turned around. But I was so frightened after the ileus, I refused to eat. I was terrified of toast. I was NPO (except water) for about 12 days in all. 13/18

But still. I was so lucky. I had incredible nurses. I had wonderful doctors. I got stellar care. I had a treatable, acute illness. And, I had health insurance, so I had no concerns about my future after I recovered. 14/18

I went home and gave myself ceftriaxone BID for the rest of my 2 week course via a PICC. I worked on my strength. I peed A LOT to lose all that residual fluid. I went back to the gym about 10 days after going home. 15/18

My point is – I’m a trained EM-CCM doc, who was married to a Pulm-CCM doc, and we had no idea what was going on or what to do. We were terrified. And, really, I wasn’t even that sick. I was lucky – I had an easily treatable bacterial infection. 16/18

It was still so disorienting and confusing. I couldn’t give a coherent history. I was totally dependent on my nurses and doctors. I had to trust that they were doing everything right. (They were, but still. That’s a lot of trust.) 17/18

I thought I had empathy for my patients before, but I did not understand how scary, how disorienting even an acute illness is.

Be gentle with your patients. They have stressors you don't see. They are more scared than you realize. Small kindnesses mean more than you know. 18/18

Oh, and PLEASE put back the bedside table. That was my #1 pet peeve - doctors would come in, move my table away to examine me - the table with my glasses, my water (pre-ileus). . . and leave it out of reach. Then I would struggle, blind, to get it and pull it back over. #impolite